Ketamine for depression: a potential role in requests for Medical Aid in Dying?

A Canadian patient with severe, prolonged treatment-resistant depression who was actively requesting Medical Assistance in Dying (MAiD) experienced remission after a course of intravenous ketamine infusions. This is the first reported case of any intervention yielding remission in a patient who would otherwise likely have been eligible for MAiD for depression. The case raises questions about evaluating MAiD requests for psychiatric disorders, particularly regarding the definition of irremediability—whether a patient lacks any reasonable prospect for recovery. The authors suggest that a trial of ketamine warrants consideration in similar cases.

Study at a glance

Abstract

Medical Aid in Dying (MAiD) is the act of a healthcare provider ending a patient's life, at their request, due to unbearable suffering from a grievous and incurable disease. Access to MAiD has expanded in the last decade and, more recently, it has been made available for psychiatric illnesses in a few countries. Recent studies have found that such psychiatric requests are rapidly increasing and primarily involve mood disorders as the primary condition. Nevertheless, MAiD for psychiatric disorders is associated with significant controversy and debate, especially regarding the definition and determination of irremediability - that a given patient lacks any reasonable prospect for recovery. In this article, we report the case of a Canadian patient who was actively requesting Medical Assistance in Dying for severe and prolonged treatment-resistant depression until she experienced remarkable benefits from a course of intravenous ketamine infusions. To our knowledge, this is the first report of ketamine or any other intervention yielding remission in a patient who would have otherwise likely been eligible for MAiD for depression. We discuss implications for the evaluation of similar requests and, more specifically, why a trial of ketamine warrants consideration.